What is Husband-Coached Childbirth
Robert A. Bradley M.D.

Now, by way of introduction, it was 18 years ago this spring that the little girl I married 27 years ago shoved under my nose a book. "Natural Childbirth" by Dr. Grantly Dick-Read. Childbirth without pain. It sounded too simple and yet as my wife said, it made sense. It bothered me. So, I tried it out and I picked the next to the world's worst possible obstetrical patients. I think the biggest risk obstetrically would be pregnant doctors - female variety. I couldn’t' find enough of these to make up a series. So I took the next worst possible risks and that was nurses having their first baby. I found 90 of them in the next two years at the University of Minnesota graduate school.

Now with all due respects to my female colleagues, and also the most overworked, underpaid women on earth, I think, nurses, why are they such poor risks obstetrically? Because they know too much. They know too much negativity associated with what should be the most beautiful, wonderful experience in any couple's life, and dig that "couple." I fully believe that it takes two to tango. Now I got that way by experience because of number 36 nurse, 18 years ago.

This girl, who happened to be one of the most statuesquely, physically built specimens and I think psychologically and spiritually beautiful, was one in the series of 90. In fact, in those unaware days, it was the days preceding the time that doctors awakened to the fact that husbands are rather necessary item to have around. And we did not allow husbands to be with their wives in those days. And I was playing then, the role that I have since assigned to the husband. And I doing experiments and I had a long sheet of paper and I was sitting by each one of the experimental nurses' side. It was their first baby and I was running some very fundamental little experiments. I was having them do one thing, then another, and then I would objectively evaluate what effect this change of activity, breath control, tension, positions and so forth had. This particular nurse, I sat by her side as I did all the rest and we went into the so-called "delivery" room. And for those, in those days, it was a delivery room. And for those who don't know what we were giggling about when we mentioned the "birth" room earlier, I have made somewhat of an issue over that word "delivery." I hope I have convinced you that we have "birth" rooms instead of "delivery" rooms. But in this particular time we took this beautiful girl, in second stage labor, down to the birth room. Now, at the University of Minnesota they have galleries. And in those days natural childbirth was really rare. And whenever one of our experimental nurses was in labor we had that gallery packed to the gills with everything from scrub ladies to the student nurses and student interns, and residents. To me there's no more unimportant part of obstetrics that this great big deal of a man putting his hands there and a woman pushing a baby into them. But after the birth was over I took off my gloves, walked around the table and shook hands and congratulated the patient on her good cooperation, thanks her profusely on her cooperating with me on my study and so forth, in a very formal way.

However, the birth of a baby is not a formal experience to any woman who experiences it consciously without her mind clouded with medication or her body paralyzed by needles in her spinal fluid. This woman was exuberant, and she was so grateful that she grabbed me suddenly - and my feet were just a little damp form the salt water that comes with babies - I awkwardly fell on top of her as she kissed me. And farmer by origin, I blushed profusely, the audience laughed uproariously (I'm still kidded about my bedside manner) particularly the most statuesquely beautiful nurse in the serious.

We had an agreement with these 90 nurses that they would cooperate in every way before we started these experiments, one of which was to walk out the birth room. And we were walking out of this room with this group of nurses, medical students and this patient carrying her baby in her arms - walking back was required of those 90 nurses - and we walked around the corner and I had forgotten all about the husband. There say the young, handsome lover and husband in the so-called "waiting room."

Now some of you may have heard the tape recording that I did on the radio with an opponent of our method and you may have noticed that I spoke with a certain degree of hostility. I didn't recognize it myself until I heard about it later - I was irritable and I was hostile because I had been kept in the "waiting room" of that radio station - having come from Denver for that purpose - for one hour. By myself, pacing the floor. And then I was gratuitously called in and this other man just came in and sat down. It makes me irritable to wait and pace the floor feeling utterly useless in the waiting room.

This young husband was in that waiting room, his pupils dilated with fright to begin with, "did my wife pull through all right?" And here I was, as the doctor, with her lipstick on my lips, with laughter and gaiety in the minds of everyone -- we had forgotten all about the man who had started the whole business. I was so shocked and obstetrically so ashamed of myself, literally, that she would feel so much gratitude towards me. She said, "Thank you, thanks you for showing me how to act." Thank you -- she was so grateful that I had coached that the thought occurred to me (that was 18 years ago) why doesn't she fall more in love with her husband instead of her obstetrician.

That old cliché that every pregnant woman falls in love with her doctor may be related, it occurred to me, with the simple fact that she hasn't got her husband around to fall in love with at the time that she has the most intimate experience of her life and that's the conscious birth of her baby. The realization his me so strongly that I marched down the stairs to the very startled hospital administrator and asked, I believe, for the very first time in this nation for a hospital policy to be changed to allow a husband to share this wonderful, joyful experience with his wife. I never realized at the time how many various alleys that would lead me down but I stuck to my guns and if anyone knows the history of me very well, I plan on continuing to stick. Because the privilege of being with your wife when she's bearing your child, gentlemen, comes under the realm, not of the hospital policy decision, nor a medical decision, but it comes into the realm of a basic human right. And like all basic human rights, we shall prevail. That's why I'm here now.

I did get the permission. This was experimental in nature. I think I frightened the hospital administrator. He took out more liability insurance I know. But now, 18 years later, and 7000 husband-coached childbirths later I have no regrets. In fact, I have a great paternal pride. And I'm here smiling because I found some lovely things in this city. I found Dr.'s Ellis and Hoage, for instance, who feel as I feel and have the courage to stand up and say so in public. And the camel's nose of these nice doctors, you'll pardon my expression, is in the tent and I know if I'm invited back later on, I'll find that whole camel in there because I've seen this happen in Philadelphia and Milwaukee, Dallas and it shall be in Los Angeles too and the other cities of your wonderful state.

Now, I found that when I brought the husband in, again I had a lot of things to learn. I didn't really knows much about human relationships then - I'm not sure I do now - but I know a lot more than I did then. I found that if I brought the husband in and simply sat him down like a bump on a lot in the labor room and in the delivery room that I had a more cooperative patient - I had a calmer patient - and I had a far more happier patient. And I noticed that in case I moved his chair back out of the road where his wife couldn't see him she would tend to panic and lose her self control. When he said nothing and did nothing but was simply there, his presence was felt.

I found that this is rather an insult toe ask of an intelligent fellow man to sit like a bump on a log and the nurses would come in and perform simple little nursing tasks and the doctor would come in and check and guide and talk and instruct so it dawned on me why in the world don’t' we put him to work? He and intelligent man. And he's a bored man. So I conceived the idea of assigning the definite tasks to this man, and turning the responsibility of the conduct of his wife's labor entirely over to him. And then I found out that I like to compare having a baby as an athletic event because I firmly believe that that's what it is. Natural childbirth is comprehensive total obstetrics in which we prepare a woman for the advent of the birth of her baby in the same way as though we prepare an athlete.

I have, since those days, completely revamped my whole practice as a woman's specialist and approached it via the men. As I say in our introductory talk to our new bewildered young couple - each month we have this introductory talk - I don't deliver babies. I have the privilege to teach men how to teach their wives to give birth to babies.

We orient our entire approach to the male - to the head of the family, the man. We point out that if this is logical perhaps we'll get some degree of cooperation here and not only in the birth process itself. You've heard at this convention that I pooh-pooh this as the most unimportant part form the doctor's standpoint. The most unimportant part of the entire process is the actual birth of the baby. From the doctor's standpoint. It's spiritually and psychologically and intimately very important to the parents but our job as doctors has changed. Instead of being pompous and aloof in our ivory tower with patients looking up to us as the knower of all things we have descended from this rather ridiculous position in the new concepts of psychosomatic medicine and have become, instead of mere forceps mechanics, teachers and educators.

This is a form of parent education and we have utilized the husbands for the last 18 years. We have 3% caesarian sections rate, my partner and I, like most other hospitals and doctors. Though we have the remaining women who do not have physical abnormalities and can bear their children through the birth canal a 96.4% spontaneous, unmediated birth rate. Now I think this, as far as I know, is the highest boasted in medical literature, unless there's some statistics I haven't seen. And I think the reason it is so high is not related primarily to the doctor and I don't really think it's related to the mother. I think it's related to how we utilize husbands as labor coaches. That this is the main difference in our method, in our approach, that makes such a difference in our statistical results.

Our bodies in the evolutionary process have not yet caught up with the fact that somebody taught us to walk on our hind legs. As a result of the pull of gravity in that position we have the problems of varicose veins and hemorrhoids, we have the tipped uterus, the cramps and chronic backaches that make life miserable for women who follow Emily Post methods of housekeeping. We teach that husband that his two-legged animal can and should be converted to a four-legged one before it goes to sleep every night. We also teach that the women who have had babies before should get on all fours mid-morning and mid-afternoon because of the tendency for the baby to be carried lower.

Alright then, we find that husbands as pregnancy coaches preparing for the game of having a baby are just wonderful at making the women follow a good diet. We give them a list, printed with high protein, low fat, low carbohydrate, low salt. Your wife shall eat the following permitted foods and she shall not eat the ones forbidden. You would be amazed how the men see to it that their wives maintain their figure. And we have some of the most statuesquely beautiful women, we think, from the cooperation we get form their husbands who, because they love them, see to it that they do what is right. This is a challenge but we feel it is essential to educate the husbands and we find that it works beautifully.

Now, in preparation for the actual birth itself, we find there are certain little fundamentals that require a dress rehearsal. I found back in those days when we brought the husband into the so-called delivery room (we call it the birth room) that it was better for him to have a task to perform rather than to just sit there. Instead of the nurse coming in to rub the patient's back and to slip ice chips into her mouth, adjust the pillows, etc., the husband is assigned these tasks.

Incidentally we ask the husband to come home late form the poker party sometime during the last three months. The object of this is to take off his shoes and tippie-toe in so that he doesn't awaken his big-tummied wife. He studies her natural sleep position for use during labor.

Natural childbirth is based upon a simple fundamental principle. Every animal on God's beautiful earth that falls in forty feet of water swims, except the one non-instinctual and somewhat stupid animal known as homo sapiens. You have to teach them what to do in water or they will drown. Every animal gives birth to its young spontaneously. You don't drag gas machines and caudal needles out into the woods when a mother fox, wolf, sheep, you name, is having a baby.

But human animals have to be taught to give birth. They do not know how to conduct themselves in labor. They have to be trained. One of the fundamental principles we go into in great detail is that of using the natural position which the woman assumes during sleep for relaxation during the first stage of labor. Therefore he studies this late some night when she doesn't know she is being observed. There are many variations of arm and leg position. Some ladies cuddle with their arms underneath them and they use two pillows for their head. Some sprawl in a running position and use no pillow at all. Some like a pillow under their raised leg.

One thing we find consistent - all lay on their side. I have never found a husband whose wife lay flat on her back with eighteen pounds of uterus on top of her. But he didn't have to tell me that because I grew up in the country. If you ever go out and find an animal lying on its back with it's four legs extended heavenward and a uterus full of babies on top, go home and get a spade and come back and bury it.

I blush with shame for my beloved profession because only eighteen years ago when I first started in practice I saw restraints slapped on women to hold them flat on their back because it was more convenient for the nurse to get the fetal heart beat. Let us pray that the medical profession awakens to the fact that patients are human beings. Despite the fact that in teaching natural childbirth we help them understand instinctual behavior which humans must learn, we do no consider our patients as animals. We try to consider them as total individuals with a body, a mind and a soul. Natural childbirth is the comprehensive obstetrics which include recognition of all three of these.

For actual first stage I used to sit at the bedside prior to husband being allowed in to give reassurance and to help them relax. We notice in animals that during labor they loosen all their muscles. Women need to be reminded to go limp in the same way. However, I as a doctor found that I have a voice that is far from conducive to relaxation. I discovered by actual experimentation that there is nothing as effective as the familiar voice of the husband whispering in his wife's ear the same love line of gobbledy gook he whispered in her ear in the moonlight that started this whole business in the first place.

This is the job we assign him. To use this pattern of intimate love talk at home as a going to sleep procedure. He also learns to put his hand on her abdomen to help her with diaphragmatic or abdominal breathing. While he is doing this he is whispering in her ear anything which he as a lover finds relaxing to his wife. Nothing in more interesting to hear. I am continually amazed at the variety of patter. I remember on, for instance, who was literally giving a travelogue of highway 101. He was describing softly the sound of the seagulls, the crashing of the water on the boulder, the smell of the salt spray. This was trip they had shared the year before and that woman was the most relaxed person you ever saw. I feel we as doctors intrude when we enter to see how things are going and see our trained couple working together toward the birth of their child.

But I get ahead of my story. Before the relaxation phase where the bedroomy atmosphere is so important comes the foothill part of labor. I got this concept from Dr. Atlee of Nova Scotia, relating labor to mountain climbing. When labor is no yet well established there is no point in going to bed and doing concentrated relaxation or abdominal breathing. There is no need. So we have our patients and their husband walk hand in hand around the lounge, look at the babies in the nursery our go down the hall and back and generally putsy around. But not go to bed until contractions get close and hard. Then we want her to go to bed and then they begin to work at relaxation. I want them to have a reason to concentrate on this. It requires intense concentration and cannot be sustained over six hours at a time.

You can't beat a husband as a companion in labor. To me there is nothing more hideous than a woman alone in labor. But there is no better companion than the man she loves and I hope loves her. However, they learn that when she needs to concentrate on going limp the talking part is over. When you get to the steep part of the mountain you don't have much left over for chatter. As her work time gets longer and her rest time between contractions shorter she becomes much less companionable. When I first started out I forgot to teach men this. One man went to hold his wife's hand and show her how much he loved her during a contraction. He didn't get bit literally (as he might have if he had done this to an animal in labor) but he got bit figuratively. She said, "Oh, let me alone and go away, I'm busy." He was hurt. He wanted to be helpful and you have to teach him how.

If you disturb the concentration that any mother must have in order to summon the total self control during a uterine contraction you are going to get snapped at. Now I remind classes that one time when I tried to take a picture of my wife's French poodle having a pup I got snapped at by this wonderful sweet little mother poodle who loves me just as much after the birth as she did before she had pups but she would not tolerate me during labor. Thus we warn husband of the irritability some women get if they are disturbed. We tell that husband in explicit detail how to conduct himself in relation to her as the mountain gets steeper and steeper.

Then we enter transition that preceded the pushing part. We compare it with the plateau that precedes the summit of this mountain that is being climbed. We warn husbands to be quiet and not disruptive, to rub the back on between contractions. At this point she will want to change from the side to the contour chair position. It is husband's job to turn two cranks at the foot of the bed to help her into a semi-sitting position. He has to find out just how high she wants to go. We find, I'm not sure why, but she is able to breath better and control herself better in this position during transition than on her side.

However, we teach that there is no sense in arguing. If one woman happens to like the side position better then we tell the husband let her do what she likes. She is boss. She knows how she feels and when she is comfortable and we don't. Then comes the pushing part. This is the climax, the top of the beautiful mountain where the wonderful view will appear. They are going to have one of the most intense experiences possible - he is then to encourage his wife, saying, "we are going to see our baby very soon." When it is time to push we are nearly there at the summit. We encourage husband to bring cameras to bake a picture of the view we are talking abut their very own baby, the blending of two people's love into a new individual. There is something holy about that. I agree with this lovely lady here, Dorothy Nolte who said that giving birth is a spiritual growth experience.

I have Dr. Max Bartlett, a young specialist working as my partner. He has been with me six years. Where did I get him? He was an intern going by the delivery room door and heard laughter and giggles coming from it. He had never been taught anything about that in medical school. He became curious and opened the door to see what was going on. We explain to husbands that in between pushes his wife will be companionable again. She may become downright garrulous and I don't know why this is, but between pushes in second stage of labor our trained, educated, calm, self-controlled mothers just love to talk. They come out of transition stage where they didn't want a word spoken by anybody. Then they start pushing which is much easier and more satisfying. I guess doing something is easier than doing nothing.

In second stage the about-to-be mother has longer rest periods between contractions which are now farther apart. The uterus is partially empty. The cervix is completely dilated, and the baby's presenting part has slipped through. It's as if the uterus says to the woman: "Okay, I've odne my work, now it's up to you." In other words the mountain literally levels off just before you get to the summit. This makes for much better control.

What would happen if you stuck needles in the spine and paralyzed a woman at this stage? (As I hear is somewhat popular here) What would happen? Nothing! Because the uterus has done its work and now it is up to the mother but she's paralyzed or asleep. Good heavens! Let's wake up to the fact that this is the simplest, easiest part of all childbirth. It is the part in which you're sticking needles in their spine and paralyzing mothers and putting them to sleep.

I asked 4000 mothers who had babies without medication, without their minds clouded " If I were to force upon you complete paralysis or 10 minute of absolute sleep what part of labor would you ask this for if you had to have it whether you wanted it or not?" Not one of those thousands ever said the birth process or second stage labor! They all said "Transition stage, just before pushing time." Then will you tell me why in the name of heaven do you accept paralysis or sleep at that particularly manageable stage of labor? I have no patience with such silliness, especially when I know what it does to babies.

Alright now, in the second stage we put this husband to work. He adjust the pillows. He slips ice chips in her mouth in between contractions. He also is the coach of breath control in second stage as well as first. We notice that at home they practices three deep breast before beating down with the breath held. Any swimmer who swims an underwater race will stand at the edge of the pool knowing he has to do his exertion, violent exertion, on one breath and therefore he wants all the fresh air and oxygen he can get in order to do the job better.

We teach our labor coaching husbands "Your wife shall do athletic breathing to wash out the stale air and get that live oxygen way down into the bottom. They feel this in their lungs and then they are able to push leisurely; not frantically, while holding the breath until the baby descends and enters the world.

This point when the baby actually passes through the labia is called the birth climax by Helen Wessel in her book "Natural Childbirth and the Christian Family." There is, on the part of the mother as the baby passes through the labia minora, a clitoral stimulation which causes a special feeling. Many a husband has told me this spontaneously, "Why, she acted and sounded just like she does when I make love to her. She makes the same little sounds when the baby comes out as when the baby went it." And I've had a student nurses tell me that they felt embarrassed in a natural childbirth room because they felt like they were intruding into the bedroom of a married couple making love.

This intimate interpersonal relationship is observed by the doctor because the moment the baby slips through I look up at the head of the bed where that husband is sitting on the daddy stool. The daddy stool is that stool which in the ancient "knock-em-out, drag-it-out" days was used by the anesthetist. And the day is coming when it will be occupied properly by the father of the baby. We notice the kissing, the loving, and the intimate exchange of little sounds between husband and wife at the head of that table as the baby passes through the birth canal. Something wrong with that? We don’t think so.

Our graduate husbands who have been with their wives, who have coached an guided, have seen by actual experience the necessity of their presence make distinct nuisances of themselves in the ancient black holes of Calcutta. One chained himself to his wife here and left the key at home. Another handcuffed himself to his wife. Mr. Charles Rolands - any here from Portland, Oregon will know what I'm talking about - what did he do in Portland? He sued the hospital for the privilege of being with his wife. There is no law on earth that would prevent a determined mad from sharing the childbirth experience and in court we have heard our husbands defend themselves: "Judge, I love my wife and she needed me." And he not only won his case and got his injunction that allowed him to be with his wife but the entire audience in the courtroom rose and applauded. But it isn't it a silly country that makes such things necessary?

Now, you are living in Los Angeles, and I am delighted to find from Dr. Hungerford that St. Luke's Hospital in Pasadena, St. Vincent's Hospital in Los Angeles, and the Rose Hospital in Los Angeles are on the list already.* There's that camel's nose already in the tent. Two wonderful doctors who feel as I feel and dare to be Daniels and stand up and express their feelings in spite of the browbeating they're going to get from their colleagues.

So we meet the challenge. This is the modern age and like all human rights, the privilege of being with your wife is here to stay. I heard the comparison of the religious atmosphere that should be maintained in the birth room made by Dorothy Nolte here this afternoon. That I heartily agree with. May I close as I closed my book "Husband-Coached Childbirth"? I have the greatest admiration for all religions. I happen to be a Christian and we celebrate a "BIRTH" day (not a delivery day, mind you, but a birth day" on December 25. And this birthday is, I think, even more deeply symbolized because of the absence of anesthesia machines in Bethlehem, and the presence of Joseph.

*White Memorial Medical Center
Hospital of the Good Samaritan Medical Center
Community Hospital of Los Angeles

This is a transcript of the Keynote Banquet speech given by Dr. Bradley during the Western Regional Conference of the ICEA held in Los Angeles and hosted by CEALA in March 1965 at the University of Southern California campus.

For a full discussion of the concepts of Husband-Coached Childbirth read Dr. Bradley's book by the same title.


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